Dr. Cheeko versus Dr. Ticho

Here on Point Pleasant Beach there’s a famed spot, Martell’s Tiki Bar, that sports a legendary band, Dr. Cheeko.  We love visiting Martell’s on the weekend, or during the summer season, where Cheeko is a fixture.  What lends charm to Cheeko, at least for us, is his moxy.  He’s got the guts to flaunt his Phillies gear in the midst of Yankees/Mets territory (mostly Yankees).  And he plays so well that the Martell’s clientele looks beyond his appearance and dwells instead on the music which is Caribbean-infused and has a style of its own.  He forges a personal relationship between you and his music, and between his identity and yours.

I cite Dr. Cheeko as a model for a new approach to long-standing critics of developmental vision and optometric vision therapy.  It is a brash pride about who we are and in what we do.  It is unapologetic and it will be relenting until our critics get the message.  It rejects “turning the other cheek” in a pacifistic manner.  What prompts me to say this?

Let me give you just the latest example of misinformation that we and our patients contend with.  Here’s the cover of the second edition of a book entitled “ADHD: What Every Parent Needs to Know.”  It is published by the American Academy of Pediatrics.  This is the organization with whom our ophthalmologic colleagues readily join to issue Joint Policy Statements that obfuscate what we do.  Let me cite what is written in the book in a three paragraph synopsis of what they call “Optometric Training”.  Bear in mind again that this is published by the American Academy of Pediatrics in 2011:

“Optometric training, a kind of training for children with learning disabilities, is based on the theory that faulty eye movements and problems in visual perception can cause dyslexia, language disorders, and other learning problems that frequently accompany ADHD.  Named behavioral optometry by the optometrists who developed and support this form of therapy, the treament consists of teaching children specific visual skills as a way of improving learning.  These skills include tracking moving objects, fixating on locating objects quickly and accurately, encouraging both eyes to work together successfully, and changing focus efficiently.  The skills are taught through the use of eye exercises and special colored or prismatic lenses.  Optometric training is often supplemented with training in academic skills, nutrition, and personal relationships.  This treatment is frequently quite expensive.”

I’ll let that paragraph and its selective information stand on its own merits, but the paragraph that follows is a citation of the 1984 version of the AAP’s Joint Policy Statement which we know is used principally to dismiss vision therapy out of hand.  We’ve discussed the role of this and similar statements as part of the body of misinformation that constitutes the myths and fallacies about optometric vision therapy.  This is followed by the final paragraph, which begins with this outrageous statement:  “Because vision training is not only ineffective but may delay more effective treatment for coexisting learning disasbilities, it is not recommended.”

In the discussion section of a blog piece I posted the other day on How Ophthlamology Still Gets It Wrong, there is a comment by Dr. Benjamin Ticho on how my tone on the subject of pediatric-ophthalmo-bashing of VT is hostile.  I disagree.  What I do admit is that I have a strong opinion and am free to express it.  I do so on behalf of at least two constituencies of sorts:

First and foremost are the patients who are left to discover optometric vision therapy for themselves, often after years of struggle.  Here is a sampling of those who I have in mind as I write, and the blogging names they’ve adopted to go public with their experiences, a very courageous thing to do:  Stereo Sue, Strabby, Greg Voth, and Robin & Jillian Benoit, just to name a few.

Secondly and just as important to me are the young colleagues in our field who are making a name for themselves, one who is my son and the other who I consider to be a son,  Dr. Daniel Press and Dr. Bryce Appelbaum.

 

It doesn’t take long to “practice in the trenches” before they become exposed to  three classes of pediatric ophthalmologists:

1) Those who actively seek to poison optometric vision therapy.  These practitioners promulgate the AAP position cited above chapter and verse, claiming that vision therapy is not only ineffective but may delay more effective treatment for co- existing learning disabilities, when in fact there is not a single shred of evidence that this is true.  Even if the patient has had umpteen prior therapies and interventions, so that the excuse of “delaying other treatment” is inapplicable, they would sooner leave the patient with the impression that optometric VT can’t possibly be of benefit rather than endorse it.  In one sense I respect these colleagues because they do not hide their disdain of our field, and we as well as the patient know where they’re coming from.  In fact the more irrationally they rail against vision therapy, the easier it is for the patient to see through their emotional veil shrouded in scientific concern.

2) Those who are ostensibly neutral toward or perhaps seemingly supportive of optometric vision therapy.  This class might say something on the order that they aren’t familiar with the field, but they know that it is controversial.  A distinct subclass is the snake-in-the-grass who claims: “Some of my best friends are optometrists”.  In other words, I  do vision therapy (meaning they have a staff person who instructs the patient on pencil push-ups or a computer program).  If it were indicated for you (or your child) don’t you think I’d recommend it?  And the new corollary:  “If I felt that office based therapy for 6 or 9 months were in your child’s best interests, don’t you think I’d recommend it?  After all, it would be in my financial interest to do so”.  (Notwithstanding that this individual has neither the training, knowledge or management skills to successfully conduct weekly in-office therapy for most of the patient population that we successfully help.)

3) Those who are genuinely supportive of optometric vision therapy.  This is a rare but hopefully increasing group who acknowledge that optometric vision therapy is a distinct field of practice.  They do not hold themselves out to be authorities in the field, and they acknowledge the body of knowledge unique to developmental and behavioral optometry.  Rather than trying to contain all patients in a medical setting or hold them hostage in a medical home, they freely endorse doing whatever is in the best interests of they patient.  Much as they would defer to the expertise of an occupational therapist for opinions about sensory integration therapy, they would defer to the opinion of a developmental optometrist about optometric vision therapy.

I’ll let you draw your own conclusions about where the opinions expressed by  Dr. Ticho and Dr. Granet lie on this three class continuum.  On the surface these doctors read my comments, regard me as hostile in some sense, and call for peace in the name of progress.  With no intent here on confounding politics and patient care, while watching the video of the White House Meeting yesterday between Israeli Prime Minister Netanyahu and U.S. President Obama, I was struck by something that Netanyahu said.  To paraphrase, as a leader Netanyahu is humbled by the obligation he feels to the deep history of his people, yet there were certain proposals laid down publicly by President Obama that simply weren’t tenable in the pursuit of peace.  Was Obama being politically naive?  Did he have an ulterior motive or alternate agenda?  Who’s to say what fueled the discussion.  What we saw on the surface was two leaders, each passionate about their point of view.  But if you are an Israeli citizen, there can be no concession when it comes to safeguarding your existence.

There will be no concession on my part, nor on the part of the practitioners who I represent, about the solidity of  the clinical principles and science on which our success hinges.  It is time to demand that those who seek to undermine our credibility be ethically accountable for what they tell patients about our services.

I’ll end on a note from the AAP statement above which actually has kernels of truth:

“Optometric training is often supplemented with training in academic skills, nutrition, and personal relationships.  This treatment is frequently quite expensive.”

Yes, ladies and gentleman, and deservedly so.  Cheeko wouldn’t have it any other way.

- Leonard J. Press, O.D., FCOVD, FAAO